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Journal of Ultrasound in Medicine, Vol 19, Issue 7 427-440, Copyright © 2000 by American Institute of Ultrasound in Medicine
Quantitative vascularity of breast masses by Doppler imaging: regional variations and diagnostic implications
C. M. Sehgal, P. H. Arger, S. E. Rowling, E. F. Conant, C. Reynolds and J. A. Patton
Department of Radiology, University of Pennsylvania, Philadelphia 19104-6086, USA.
Seventy-four biopsy proven breast masses were imaged by color and power
Doppler imaging to evaluate vascular pattern of malignant and benign breast
masses. The images were analyzed for vascularity. The measurements were
made over the entire mass as well as regionally at its core, at its
periphery, and in the tissue surrounding it. The surgical specimens were
analyzed for microvessel density. The diagnostic performance of Doppler
sonographic vascularity indices was evaluated by receiver operating
characteristic analysis. The malignant masses were 14 to 54% more vascular
than the benign masses. Both types of masses were more vascular by
ultrasonography than the tissue surrounding them. Whereas benign masses
were 2.2 times more vascular than the surrounding tissue, the malignant
masses were 5.0 times more vascular. In a subset of patients the regional
vascularity at the core, periphery, and surrounding tissue by Doppler
imaging exhibited a strong correlation (R2 > 0.9) with the corresponding
histologic microvessel density measurements. Although the malignant masses
exhibited a strong gradient in vascularity, core > periphery >
surrounding tissue, the benign masses had relatively uniform distribution
of vascularity. The area under the receiver operating characteristic curve
(A(Z)) for the Doppler indices ranged from 0.56 +/- 0.07 to 0.65 +/- 0.07.
A nonlinear analysis including age-specific values of Doppler indices
improved the diagnostic performance to A(Z) = 0.85 +/- 0.06. In conclusion,
quantitative Doppler imaging when used in combination with a nonlinear
rule-based approach has the potential for differentiating between malignant
and benign masses.
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